Pressure Ulcers-Sores

Our Services-Pressure Ulcers-Sores

Treating Pressure Ulcers

Pressure ulcers, also known as pressure injuries, bedsores, or decubitus ulcers, are localized damages to the skin and underlying soft tissue, typically over bony prominences, resulting from prolonged pressure or shear. Affecting up to 3 million people annually in the U.S., they pose significant risks in immobile patients, such as the elderly, spinal cord injury survivors, or those in critical care, potentially leading to prolonged hospitalization, infections, or even mortality. This scaled guide, drawing on the 2019 NPUAP/EPUAP/PPPIA International Guideline (with the 4th edition launched as a living document in February 2025), outlines identification, severity-based treatment, and prevention to facilitate healing and minimize complications. A multidisciplinary approach involving nursing, nutrition, wound care specialists, and physical therapy is essential for optimal management.

Understanding Pressure Ulcers-Sores

Understanding Pressure Ulcers: Types and Severity Scales

Pressure ulcers develop when sustained pressure exceeds capillary closing pressure (8–12 mm Hg for venous return or 32 mm Hg for arterial flow), causing ischemia, tissue deformation, and necrosis, often compounded by friction, shear, and moisture. Muscle and deep tissue damage precedes visible skin changes.

Types include:

  • Blanchable Erythema: Early precursor, reversible with relief.
  • Medical Device-Related: From tubes, masks, or braces pressing on skin.
  • Mucosal: On GI/respiratory/genitourinary linings; unstageable due to anatomy.
  • Deep Tissue Injury (DTI): Subcutaneous damage manifesting as purple/maroon discoloration under intact skin.

The National Pressure Injury Advisory Panel (NPIAP) staging system, updated in 2016 and reaffirmed in 2025 guidelines, classifies by depth for communication and treatment planning:

  • Stage 1 (Mild): Intact skin with non-blanchable erythema of a localized area, usually over a bony prominence; skin may be painful, firm, soft, warmer, or cooler than adjacent tissue. Heals in days to 1 week.
  • Stage 2 (Mild-Moderate): Partial-thickness skin loss with exposed dermis; presents as a shallow open ulcer with red-pink wound bed or intact/ruptured serum-filled blister. 1–3 weeks to heal.
  • Stage 3 (Moderate): Full-thickness skin loss with damage to subcutaneous tissue, but not through underlying fascia; may include undermining, tunneling, or slough; granulation tissue visible. 1–3 months.
  • Stage 4 (Severe): Full-thickness loss with exposed muscle, tendon, bone, or cartilage; often with slough/eschar, undermining, or tunneling. >3 months; high risk of osteomyelitis.
  • Unstageable (Severe): Obscured base due to slough/eschar; depth unknown until debrided.
  • Deep Tissue Injury (Severe): Persistent non-blanchable deep red/purple/maroon discoloration or blood-filled blister; may evolve rapidly to Stage 3/4.

Common sites: Sacrum (70%), heels, hips, elbows. Symptoms: Pain, warmth, exudate, odor in advanced stages.